| NPI | 1790203974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12013920A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9968) |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2022-10-05 |